Health Care Thoughts: Conference Wrap-up
by Tom aka Rusty Rustbelt
Health Care Thoughts: Conference Wrap-up
So I do some conferences with a lot of people who are way smarter than me, people literally and figuratively on the cutting edge.
What thoughts are dominating health care these days, especially the provider community? Here is a list of frequent talking points, further in-depth discussion of some of them later.
The provider community is in chaos, seeking “what is the best strategic move to insure survival?”
The focus of Obamacare isn’t clear, is it?
- quality is paramount
- cost reduction is paramount
- both are paramount
- nobody knows
- something will evolve
Integration is the biggest trend now, pushed by Obamacare
The feds (CMS, DOJ, FTC) are inconsistent about integration
Integration is pulling power and resources into hospitals and big systems
Hospitals are complex, badly managed“germ boxes” (hospital executives disagree of course)
Hospitals will continue overcharging insured patients until a better solution is found for uninsured and under-insured patients, hospital billing chargemasters are incoherent to all but the creators
Hospitals hate transparency
Hospitals have very powerful lobbies and will block anything that moves revenue out of their building
Integration is the enemy of innovation / integration is a necessary first step
Hospitals are buying physician practices and employing physicians at a rapid pace – just like the 90s some of this will eventually unravel
“Big Pharma,” “ Big Devices”and “Big I.T.” have too much lobbying power and are too dominant (personal observation – why the orthopedic device companies have not been sued for price fixing is beyond me, possibly because they negotiate enough high volume discount deals to look legit although they are not) – in a world where many prices are coming down these prices continue to rise
So far, “Big I.T.” is the top winner from Obamacare
Employer health premiums 1) are skyrocketing, employers are re-contracting with higher deductibles and higher co-pays or 2) insurers are keeping premiums level but contracting higher copays and deductibles as the standard plan – eventually this will dramatically change the insurance market, the health care market and possibly the employment markets, or 3) some combination
ANSWER to specific question from Terry– yes a portion of cost reduction is deferred care due to higher copays and deductibles plus generally weak incomes – wide spread agreement among providers on this issue – percentage nationwide? Hard to estimate
Health care is very regional and very geographical – hard to nail down exact trends
Rural health care is screwed (not enough density) unless rural providers can integrate with urban providers in a mutually beneficial manner
EMR and ICD-10 rollouts have the potential for disaster
Medicaid expansion is a good thing, but not salvation
Primary care is holding up so far, but there are risks around every corner
Dentists and veterinarians are the happiest providers these days
Insurers and employer groups are shopping to buy providers – take out the middle man approach (several health insurers are already invested in primary care networks) – could be good or bad
The last half of this year and 2014 are going to be really interesting.
Tom aka Rusty Rustbelt
Sigh.
The focus is, quite obviously, on expanded coverage.
Rusty
thanks for this.
i am a little worried that they are worried about “survival.”
provide an honest product at an honest price. there is no lack of demand.
Reminds about a post that listed all the worries about Social Security, Medicare and Medicaid. History doesn’t repeat but it does rhyme.
dilbert
i don’t hear the rhyme. Obamacare is NOT like SS, Medicare and Medicaid.
Obamacare turns health care over to the provider-insurer complex and cements what used to be called the facist marriage between corporations and the state.
Whether it provides, as opposed to claims, actual protection for ordinary people remains to be seen. My take continues to be that it merely insures that the insurance companies have customers no matter how abusive they get.
Thanks for following up on what I was hearing. In a nutshell, I think that any bending of the cost curve is due to less utilization by consumers and just like the larger economy, the group that is getting squeezed is the least powerful–the smaller or less skilled providers. The big boys and girls are getting a larger piece of a slightly smaller pie while the rest are getting by and the consumers are making decisions based on their pocketbooks rather than medical science. It is a weird thing when I have to agree that the ACA is a “train wreck” and Rand Paul actually seems to be from the same universe as me when he talks about the overreach of the intelligence community. I have to believe that all of the early talk about Hillary in 2016 is a function of the growing realization on the left–and by that I mean any part of the reality based population–that the current occupant of the White House is just not up to the job.
Got my health insurance renewal today. I am self-employed, 49, good health. Wife 39 smoker. Three kids. None of us have ever been sick other than the flu or a broken finger or ear infection. HSA, $10,000 deductible. Am currently paying $780 per month. In August will pay $880 per month. I think the cost curve is bending the wrong way!
Spent the day in Moore Oklahoma demolishing houses. Now I know what Hell looks like.
The hospital looks like it was strafed by the entire USAF.
Will rejoin the conversation when I get a chance.
little john
looks like way too much to me. but until the people are wiling to study the actual expenses, and probabilities, and demand something reasonable, or create something reasonable on their own, it’s not going to get any better.
i’ll start… i could well be wrong…. looks like you are paying ten thousand a year. that’s 200,000 in twenty years. do you have a fifty fifty chance of needing 400,000 worth of medical care in the next twenty years? or a 10% chance of needing 2 million $ worth?
nah. must be something i am overlooking.
question… how many people needing 2 million dollars worth of health care actually live through the treatment?
Damn good questions Dale. I guess the reason I have the stuff is becasue I cannot answer those questions with any certainty. Oh well. At least I get to deduct it!